Measurement of Rotational Laxity of the Knee

2011 ◽  
Vol 39 (12) ◽  
pp. 2575-2581 ◽  
Author(s):  
Mahbub Alam ◽  
Anthony M.J. Bull ◽  
Rhidian deW Thomas ◽  
Andrew A. Amis
Keyword(s):  
Supine Position ◽  
External Rotation ◽  
Accurate Method ◽  
Lower Limbs ◽  
Tibial Rotation ◽  
Intraclass Correlations ◽  
The Mean ◽  
Dial Test ◽  
Ideal Method ◽  
The Ideal

Background: Posterolateral corner (PLC) injuries are difficult to diagnose and cause significant morbidity. The ideal method for the dial test and its accuracy remain unclear. Purpose: This study compares the accuracy of measuring tibial external rotation at the skeletal level to measuring the patella-tubercle angle (PTA) and the thigh-foot angle (TFA) in the supine position to assess the most accurate method to measure rotation during the dial test. Study Design: Controlled laboratory study. Methods: Measurements were compared simultaneously using rotational goniometers at a cutaneous splint over the tibia, at a foot splint, and directly from the tibial skeleton. Six lower limbs were used. The femur was held rigidly and the knee tested at 90° and 30° of flexion. External rotation torque up to 8 N·m was applied through the foot splint, and the rotations were measured by 2 testers. Results: Measurements at the tibial splint and directly on the tibia showed significant correlation at both knee flexion angles. The mean tibial external rotation was 24° at 90° of flexion and 26° at 30° of flexion ( P < .05). The soft tissue effect caused the tibial splint to overestimate rotations by a mean of 6° and 9° at 90° and 30° of flexion, respectively. Foot splint measurements did not correlate significantly with tibial rotation, overestimating rotations by a mean of 103%. Intratester and intertester intraclass correlations were significant for the skin-mounted tibial splint measurements at both flexion angles but not for foot splint measurements at either flexion angles. Conclusion: Rotation of the foot did not accurately represent the tibial external rotation at the knee, which could be measured more accurately by an instrument resting on the skin via a molded tibial splint. These results suggest that the PTA, and not the TFA, should be used in the dial test. This would support the use of the supine position during the dial test. Clinical Relevance: The dial test is a commonly used method for diagnosing PLC injuries. This study helps to identify the ideal position and measuring points to use for this test; measurements based on the tibia were more accurate than those that used rotation of the foot.

scholarly journals Tibial Torsion and Ankle Arthritis: Is External Tibial Rotation Associated with Varus Deformity in Patients with Ankle Arthritis?

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0002
Author(s):  
Collin C. Barber ◽  
Teresa Hall ◽  
Tyler Madden ◽  
Parin D. Kothari ◽  
Monica LaPointe ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Standard Deviation ◽  
Lower Extremity ◽  
External Rotation ◽  
Varus Deformity ◽  
Tibial Rotation ◽  
Tibial Torsion ◽  
Ankle Arthritis ◽  
Ankle Arthroplasty ◽  
The Mean

Category: Ankle; Ankle Arthritis; Hindfoot Introduction/Purpose: The effect of tibial torsion on lower extremity mechanical alignment has been well studied in the literature, including its effect on lower extremity osteoarthritis. It has been suggested that external tibial torsion is associated with cavus hindfoot deformity and may lead to varus osteoarthritis of the ankle. To our knowledge, there are no studies investigating this relationship. The purpose of this study is to characterize the relationship of tibial torsion with ankle coronal plane deformity in patients with ankle arthritis. Methods: The study is a retrospective, cohort of 223 patients who have undergone total ankle arthroplasty at a single institution. Preoperative computerized tomography was used to measure tibial torsion and coronal deformity. Descriptive statistics and regression analysis were used to analyze the data. Results: Descriptive analysis of all 223 patients demonstrated a maximum of 23.9 degrees varus and 20.5 degrees valgus among all patients. The mean for varus deformity was 6.86 degrees with a standard deviation of +- 6.39. Tibial rotation was calculated at an average of 20.8 degrees external rotation, with a maximum of 15.2 degrees internal rotation and 59.5 degrees external rotation in all patients. Plotting overall coronal ankle tilt versus tibial torsion revealed overall varus deformity with R2 of 0.016. Regression analysis of all varus deformities against external tibial torsion revealed a R2 of 0.02. Varus deformity 1 standard deviation above the mean against external tibial torsion demonstrated a R2 of 0.072. Valgus deformity against external tibial torsion revealed a R2 of 6.75 x10-5. Conclusion: An association between external tibial torsion and varus ankle arthritis has been proposed in the literature. The results of our study did not show an association between tibial torsion and coronal deformity in ankle arthritis in all patients undergoing total ankle arthroplasty at our institution. A difference may exist in certain subgroups, such as patients with neuromuscular disorders, but further investigation will be necessary to determine this relationship.

scholarly journals Cryoablation of the para-Hisian region

2019 ◽  
Vol 32 (1) ◽  
pp. 6-9
Author(s):  
Nilson Araujo de Oliveira Junior ◽  
Olga Ferreira de Souza ◽  
Rodrigo Periquito Cosenza ◽  
Martha Valéria Tavares Pinheiro ◽  
Angelina Camiletti ◽  
...  
Keyword(s):  
Accessory Pathway ◽  
Reentrant Tachycardia ◽  
Early Application ◽  
Clinical Recurrence ◽  
Electrophysiological Studies ◽  
Acute Success ◽  
The Mean ◽  
Bundle Of His ◽  
Ideal Method ◽  
The Ideal

Basis: the ablation of the para-Hisian region is a challenge due to the risk of inadvertent lesion of a bundle of His. Cryoablation, due to its slower progression, allows interruption of the application in case of signs of undesired lesions and catheter adhesion during the applications, which has made cryoablation the ideal method for these patients. Objectives: to demonstrate the results of an initial series of patients referred for cryoablation of para-Hisian pathways. Patients and methods: From April 2015 to August 2017, 13 patients were referred for cryoablation due to the necessity for a para-Hisian approach detected in previous ablation procedures. Of the 13 patients, seven were submitted a radiofrequency ablation attempt (RF) and presented failure or recurrence, five performed only electrophysiological studies, and no ablation was attempted, and one was indicated primarily. The mean age was 32 ± 16 years. Eleven patients had manifest anomalous pathways (APs), one hidden and one nodal reentrant tachycardia (NRT) with a transient atrioventricular block (AB) during RF. A cycle of 4 minutes followed by one more cycle in case of a positive result. Results: Of the 13 patients, 11 had an acute success in eliminating the accessory pathway. One patient had multiple accessory pathways, one right side, and one left side. In this patient, it was possible only the ablation of the left pathway. In all others, it was observed exuberant Hisian potential at the point of application with success. The patient with NRT was ablated in the M region without intercurrences. Four applications were required on average to eliminate the accessory pathway successfully. The mean local temperature was -74 ºC. In five patients, the occurrence of third-degree right branch block (RBB) was observed. In one patient, early application of RBB was interrupted and the bonus application was not applied. This wasthe only acutely successful patient who presented clinical recurrence. Transient AB was not observed in any patient. No complications were observed. Conclusion: Cryoablation of para-Hisian pathways and NRTs in regions surrounding the His was an effective method for treatment in this population of patients refractory or refused for RF treatment. The occurrence of acute RBB does not seem to be a criterion for the interruption of applications.

scholarly journals Tibiofemoral rotation alignment in the normal knee joints among Chinese adults: A CT analysis

2020 ◽  
Author(s):  
Yufeng Lu ◽  
Xiaoyu Ren ◽  
Benyin Liu ◽  
Peng Xu ◽  
Yangquan Hao
Keyword(s):  
Patellar Tendon ◽  
External Rotation ◽  
Knee Joints ◽  
Tibial Tubercle ◽  
Tibial Rotation ◽  
Chinese Adults ◽  
Tibiofemoral Rotation ◽  
Anterior Tibial ◽  
Ct Analysis ◽  
The Mean

Abstract Background: Consensus on tibial rotation in total knee arthroplasty (TKA) remains controversial. The present study aimed to investigate the closest anatomical reference to surgical epicondylar axis (SEA) among 10 tibial markers in Chinese adults.Methods: This study included examination of 122 normal lower extremities. Briefly, 10 axes were drawn on the axial sections: transverse axis of tibia (TAT), axis of medial edge of patellar tendon (MEPT), axis of medial 1⁄3 of patellar tendon attachment (M1/3), Akagi line, Insall line, axis of medial border of tibial tubercle (MBTT), and axis of anterior border of the tibia 1-4 (ATC1-4). The mean angles between TAT and SEA and that between other axes and the line perpendicular to SEA were measured. Pairwise differences among the 10 tibial axes were examined by applying one-way analysis of variance (ANOVA) and paired t-test.Results: In all the knees, the mean angles of M1/3, Akagi line, Insall line, MBTT, ATC1, ATC2, ATC3, and ATC4 axes were compared to the line perpendicular to the projected SEA and found to be 10.2 ± 5.1°, 1.4 ± 5.0°, 11.9 ± 5.4°, 3.6 ± 4.8°, 12.0 ± 6.9°, 7.2 ± 8.6°, 7.1 ± 10.4°, and 6.6 ± 13.5° external rotation, respectively, and the MEPT axis was 1.6 ± 4.5° internal rotation. The mean angle for TAT was 4.1 ± 5.3° external rotation. The M1⁄3 and Insall line were significantly more externally rotated than Akagi line, MEPT, MBTT, TAT, ATC2, ATC3, and ATC4 axes. No significant differences were noted between the TAT axis and the MBTT axis and among the ATC2, ATC3, and ATC4 axes.Conclusion: The Akagi line, MBTT, and TAT showed good consistency with SEA in the axial femorotibial alignment with knee in extension. The middle segment of the anterior tibial crest also demonstrated good alignment consistency with SEA for the axial femorotibial alignment. Hence, these markers can be used as reliable references for rotational alignment of the tibial component in TKA.

scholarly journals Giant Haemangioma of the Liver: Is Enucleation Better than Resection?

2007 ◽  
Vol 89 (5) ◽  
pp. 490-493 ◽  
Author(s):  
Rajneesh Kumar Singh ◽  
Sorabh Kapoor ◽  
Peush Sahni ◽  
Tushar K Chattopadhyay
Keyword(s):  
Liver Resection ◽  
Postoperative Morbidity ◽  
Progressive Increase ◽  
Resection Group ◽  
The Mean ◽  
Ideal Method ◽  
Liver Haemangioma ◽  
Better Than ◽  
Made In ◽  
The Ideal

INTRODUCTION Haemangioma is the most common liver tumour. Treatment is indicated for symptomatic tumours, rapid increase in size, rupture or doubt in diagnosis. There is continuing debate regarding the ideal method of surgical treatment for liver haemangiomas, with some surgeons favouring enucleation over liver resection. PATIENTS AND METHODS Retrospective analysis of prospectively compiled database of patients who were surgically treated for liver haemangioma. RESULTS Between 1987 and 2003, we operated on 21 patients with liver haemangioma. Pre-operative diagnosis on imaging was made in 16 patients (13 symptomatic, 3 had progressive increase in size). In five patients, the indication of surgery was uncertain diagnosis. Enucleation was performed in 9 patients and liver resection in 12. The size of the haemangioma was similar in the enucleation and resection groups (8.9 cm versus 10 cm; P = 0.85). The mean intra-operatiive blood loss was significantly less in the enucleation group (400 ml versus 1330 ml; P = 0.004). The mean operative time was significantly less in the enucleation group as compared to the resection group (170 min versus 230 min; P = 0.035). Five patients had major postoperative morbidity in the resection group as compared to none in the enucleation group (P = 0.045). The duration of hospital stay was significantly longer in the resection group.(9.9 days versus 5.6 days; P = 0.005). CONCLUSIONS Enucleation of liver haemangiomas is safer, quicker and associated with less morbidity than liver resection. Except for some situations, such as uncertain diagnosis or total replacement of a lobe, we recommend enucleation as the surgical procedures of choice for the treatment of hepatic haemangiomas.

A Clinical Device for Measuring Internal-External Rotational Laxity of the Knee

2012 ◽  
Vol 41 (1) ◽  
pp. 87-94 ◽  
Author(s):  
Mahbub Alam ◽  
Anthony M.J. Bull ◽  
Rhidian deW Thomas ◽  
Andrew A. Amis
Keyword(s):  
External Rotation ◽  
Intraclass Correlation ◽  
Poor Correlation ◽  
The Novel ◽  
Altman Analysis ◽  
Rotational Laxity ◽  
Level Of Evidence ◽  
The Mean ◽  
Treatment Comparisons ◽  
Dial Test

Background: The dial test can be improved by providing reproducible, accurate measurements to improve diagnosis and treatment comparisons. Purpose: Validation of a rotational measurement device (RMD) for measuring knee internal-external rotational laxity. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: The RMD consisted of 3 components: a femoral clamp and a tibial splint using paired inclinometers to measure rotations, and a boot to apply tibial internal-external rotation torque. A separate boot inclinometer allowed for foot rotations to be measured independently. The measurements were simultaneously compared with electromagnetic “nest of birds” (NOB) sensors. Sequential paired knee measurements were taken at 4, 6, and 8 N·m of torque at 30° and 90° of flexion in 46 volunteers. Results: The correlation coefficient was 0.92 (95% CI, 0.89 to 0.94) and 0.63 (95% CI, 0.54 to 0.70) between the NOB and RMD and between the NOB and boot inclinometer, respectively. Bland-Altman analysis revealed that the RMD was on average within 2° (95% CI, 1° to −4°) of NOB readings, whereas the boot overestimated by 34° (95% CI, −9° to −58°). Maximum side-to-side differences measured by the NOB, RMD, and boot were 1°, 3°, and 21°, respectively. The mean +2× standard deviation data gave a range of side-to-side differences of less than 5° for the RMD. The intraobserver intraclass correlation was 0.9 (95% CI, 0.78 to 0.97) at both 30° and 90° of flexion, and the 95% CI of the differences between readings taken on 2 occasions, the interobserver repeatability, was 1° or less. Conclusion: The novel clinical RMD for measuring rotational laxity of the knee was portable, easy, and comfortable to use in the clinical setting. The RMD showed significant correlation and accuracy compared with sensors of known high accuracy. Side-to-side differences of less than 5° were found in 95% of normal knees, compared with differences of 13° or more for clinical diagnosis of pathological rotational laxity. Measuring knee rotation at the foot showed poor correlation and accuracy.

Localization of Intracellular Antigens in thin Sections with Ferritin Labeled Antibody

1970 ◽  
Vol 28 ◽  
pp. 174-175
Author(s):  
M.S. Shahrabadi ◽  
T. Yamamoto
Keyword(s):  
Bovine Serum Albumin ◽  
Bovine Serum ◽  
Antigenic Determinants ◽  
Conjugate Prior ◽  
Thin Sections ◽  
Specific Attachment ◽  
Intracellular Antigen ◽  
Antigen Antibody ◽  
Ideal Method ◽  
The Ideal

The technique of labeling of macromolecules with ferritin conjugated antibody has been successfully used for extracellular antigen by means of staining the specimen with conjugate prior to fixation and embedding. However, the ideal method to determine the location of intracellular antigen would be to do the antigen-antibody reaction in thin sections. This technique contains inherent problems such as the destruction of antigenic determinants during fixation or embedding and the non-specific attachment of conjugate to the embedding media. Certain embedding media such as polyampholytes (2) or cross-linked bovine serum albumin (3) have been introduced to overcome some of these problems.

X-Ray Analysis of Frozen Hydrated Sections:The Unconventional Approach

1982 ◽  
Vol 40 ◽  
pp. 754-757
Author(s):  
R. Beeuwkes ◽  
A. Saubermann ◽  
P. Echlin ◽  
S. Churchill
Keyword(s):  
Ratio Method ◽  
Frozen Sections ◽  
Technical Problems ◽  
Sample Handling ◽  
X Ray ◽  
Common Group ◽  
Ideal Method ◽  
Classic Paper ◽  
Physical Principles ◽  
The Ideal

Fifteen years ago, Hall described clearly the advantages of the thin section approach to biological x-ray microanalysis, and described clearly the ratio method for quantitive analysis in such preparations. In this now classic paper, he also made it clear that the ideal method of sample preparation would involve only freezing and sectioning at low temperature. Subsequently, Hall and his coworkers, as well as others, have applied themselves to the task of direct x-ray microanalysis of frozen sections. To achieve this goal, different methodological approachs have been developed as different groups sought solutions to a common group of technical problems. This report describes some of these problems and indicates the specific approaches and procedures developed by our group in order to overcome them. We acknowledge that the techniques evolved by our group are quite different from earlier approaches to cryomicrotomy and sample handling, hence the title of our paper. However, such departures from tradition have been based upon our attempt to apply basic physical principles to the processes involved. We feel we have demonstrated that such a break with tradition has valuable consequences.

Happiness, Virtue, and Political Society

2018 ◽  
Author(s):  
T. M. Rudavsky
Keyword(s):  
Moral Philosophy ◽  
Political Behavior ◽  
Political Society ◽  
Ideal Model ◽  
The Road ◽  
Doctrine Of The Mean ◽  
The Mean ◽  
The Ideal ◽  
Divine Law

Chapter 9 is concerned with social and political behavior. Even in the context of moral philosophy, Jewish philosophers discuss issues within the wider context of a rational scientific perspective. This chapter begins with specific moral codes developed by Jewish thinkers, focusing in particular upon the works of Ibn Gabirol, Baḥya ibn Paquda, Maimonides, and Crescas. Can there be ethical dictates independent of the commandments? The rabbis already worried whether there existed a domain of “right behavior” that pre-dates, or exists independently of, divine commandment. Does Aristotle’s doctrine of the mean apply to divine law? Furthermore, can all humans achieve intellectual perfection? Is the road the same, and open, to all? And is there only one road to ultimate felicity, or are there many routes? The chapter ends with a discussion of whether human felicity can be achieved in this life, and whether the prophet best represents the ideal model for such achievement.

scholarly journals Gender Differences in Kinematic Analysis of the Lower Limbs during the Chasse Step in Table Tennis Athletes

Healthcare ◽  
2021 ◽  
Vol 9 (6) ◽  
pp. 703
Author(s):  
Xiaoyi Yang ◽  
Yuqi He ◽  
Shirui Shao ◽  
Julien S. Baker ◽  
Bíró István ◽  
...  
Keyword(s):  
Female Athletes ◽  
External Rotation ◽  
Rotational Velocity ◽  
Knee Extension ◽  
Lower Limbs ◽  
Table Tennis ◽  
Male Athletes ◽  
Analysis System ◽  
Hip Flexion ◽  
Hip Internal Rotation

The chasse step is one of the most important footwork maneuvers used in table tennis. The purpose of this study was to investigate the lower limb kinematic differences of table tennis athletes of different genders when using the chasse step. The 3D VICON motion analysis system was used to capture related kinematics data. The main finding of this study was that the step times for male athletes (MA) were shorter in the backward phase (BP) and significantly longer in the forward phase (FP) than for female athletes (FA) during the chasse step. Compared with FA, knee external rotation for MA was larger during the BP. MA showed a smaller knee flexion range of motion (ROM) in the BP and larger knee extension ROM in the FP. Moreover, hip flexion and adduction for MA were significantly greater than for FA. In the FP, the internal rotational velocity of the hip joint was significantly greater. MA showed larger hip internal rotation ROM in the FP but smaller hip external rotation ROM in the BP. The differences between genders can help coaches personalize their training programs and improve the performance of both male and female table tennis athletes.

scholarly journals The Surgical Outcomes of Unstable Ankle Fractures in Patients Aged >65 Years

2021 ◽  
Vol 12 ◽  
pp. 215145932199776
Author(s):  
Adem Sahin ◽  
Anıl Agar ◽  
Deniz Gulabi ◽  
Cemil Erturk
Keyword(s):  
Surgical Outcomes ◽  
External Rotation ◽  
High Energy ◽  
Ankle Fractures ◽  
Medial Malleolus ◽  
Aofas Score ◽  
Non Union ◽  
The Mean ◽  
Medial Malleolus Fracture ◽  
Mechanism Of Trauma

Aim: To evaluate the surgical outcomes and complications of patients over 65 years of age, with unstable ankle fractures. Material and Method: The study included 111 patients (73F/38 M) operated on between January 2015 and February 2019 and followed up for a mean of 21.2 months (range, 6-62 months).Demographic characteristics, comorbidities, fracture type, and mechanisms of injury were evaluated. Relationships between postoperative complications and comorbidities were examined. In the postoperative functional evaluations, the AOFAS score was used and pre and postoperative mobilization (eg, use of assistive devices) was assessed. Results: The mean age of the patients was 70.5 ± 6.1 years (range, 65-90 years). The mechanism of trauma was low-energy trauma in 90.1% of the fractures and high-energy trauma in 9.9%. The fractures were formed with a SER injury (supination external rotation) in 83.7% of cases and bimalleolar fractures were seen most frequently (85/111, 76%).Complications developed in 16 (14.4%) patients and a second operation was performed in 11 (9.9%) patients with complications. Plate was removed and debridement was performed in 5 of 6 patients due to wound problems. Nonunion was developed in the medial malleolus in 4 patients. Revision surgery was performed because of implant irritation in 2 patients and early fixation loss in the medial malleolus fracture in one patient. Calcaneotibial arthrodesis was performed in 3 patients because of implant failure and ankle luxation associated with non-union. A correlation was determined between ASA score and DM and complications, but not with osteoporosis. The mean follow-up AOFAS score was 86.7 ± 12.5 (range, 36-100).A total of 94 (84.7%) patients could walk without assistance postoperatively and 92 (82.9%) were able to regain the preoperative level of mobilization. Conclusion: Although surgery can be considered an appropriate treatment option for ankle fractures in patients aged >65 years, care must be taken to prevent potential complications and the necessary precautions must be taken against correctable comorbidities.

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